Hepatocellular carcinoma (MRI)
MRI Liver (Primovist)
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There is a liver segment VI circumscribed solid mass with appearances of a capsule and a central necrotic area bright on T2, which shows a patchy hypervascular enhancement with washout on delayed phases. IP-OOP sequences do not show evidence of fat content. The lesion becomes mostly hypointense relative to strongly enhanced liver parenchyma on the delayed hepatobiliary phases. Areas of restriction diffusion are confirmed on ADC. No other focal liver lesions identified.
This patient underwent surgical resection and there was further histological confirmation of hepatocellular carcinoma.
Macroscopy: A. Labeled "Liver resection posterior". Liver measuring 145 x 85 x 65 mm. On sectioning, there is a well-circumscribed pale tan/pale yellow lesion measuring 55 x 51 x 51 mm. The lesion appears to abut the capsule and is also abutting the surgical resection margin. The remainder of parenchyma appears pale tan and unremarkable. Surgical resection margin inked black.
B. Labeled "Liver resection margin extended". A segment of liver measuring 60 x 52 x 15 mm. One side is inked black with opposing side green. On sectioning, tissue appears pale tan and homogenous with no residual lesion identified. Also, there is a further small piece of tissue measuring 15 x 12 x 10 mm which on sectioning appears pale tan and homogenous.
C. Labeled "Gallbladder". Gallbladder measuring 85 x 38 mm. Wall thickness is 1 mm. No gallstones lesions or perforation is identified. Mucosa is green with a velvety texture. Cystic duct is clamped.
Microscopy: A. The sections through the liver, appears uninked to show extension through with fibrotic capsule and a be composed of thickened trabecular structures lined by pleomorphic epithelial cells with prominent nucleoli and evidence of bile production. Within the lesion, there are no portal tract structures. Lymphovascular invasion is identified within largely dilated sinuses. Adjacent the lesion, there are reactive changes, close to a resection margin, however, the tumor is 2 mm clear of the closest resection margin. The adjacent liver shows minor steatosis and scant chronic inflammation, within portal tracts there is minor extension of fibrosis around portal tracts with early partial septa formation. foci of dysplasia are not identified. The cell cytoplasm, show focal ground-glass change.
B. The sections of liver, show generalized preservation of the architecture with minor periportal fibrosis, with patchy chronic inflammation and steatosis and evidence of ground glass change. Focal areas show dysplastic hepatocyte nuclei.
C. Gallbladder shows a thin-walled gallbladder with no smooth muscle hypertrophy, chronic facial fibrosis. Unremarkable surface columnar epithelium.
Conclusion: A. Liver resection posteriorly–55 mm moderately well-differentiated hepatocellular carcinoma, showing lymphovascular invasion, 2 mm to the closest resection margin. Adjacent liver shows features of non-cirrhotic chronic hepatitis B, stage II fibrosis.
B. Liver resection margin extended–chronic hepatitis B with focal areas of dysplasia. No evidence of malignancy.
C. Gallbladder–unremarkable gallbladder.